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Exposure of newborns to persistent organic pollutants (POPs) is a public health concern. The objective of this study was to assess the prevalence of POPs in human milk collected from lactating mothers in Lebanon and to investigate the sociodemographic, nutritional, and other lifestyle determinants. Fifty-four breast milk samples were collected as per World Health Organization guidelines. A survey was used to assess the anthropometric and demographic characteristics of participants. Dietary habits were evaluated based on a semiquantitative food frequency questionnaire. Organochlorine pesticides and polychlorinated biphenyls were measured in milk samples with liquid-liquid extraction and gas chromatography. Among the screened POPs, dichlorodiphenyldichloroethylene (DDE) was the only POP detected in breast milk samples and was found in only 17.9% of the samples, with a mean (SD) of 11.6 (5.0) μg/L and a range of 5.7 to 21.4 μg/L. Prepregnancy body mass index and age were positively associated with DDE contamination in breast milk. Women who consumed cereals at least two times per week had detectable DDE contamination in their breast milk. Consumption of potatoes and beans at least once per week was also associated with DDE contamination. Our study is the first to assess the presence of POPs in breast milk in Lebanon. The benefits of breastfeeding compensate for the low prevalence of DDE in the breast milk. Our findings highlight the high need to implement monitoring policies, good agricultural practices, and education programs for breastfeeding mothers.

Human milk is the primary source of nutrition for infants in their first year of life. Its potential contamination with perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), a group of toxic man-made chemicals, is a health concern that may threatens infants’ health. Our study aims to assess the levels of PFOA and PFOS in the breast milk of Lebanese lactating mothers and the maternal factors associated with their presence. High-performance liquid chromatography (HPLC) coupled with a Micromass Quattro micro API triple quadrupole mass spectrometer was used to detect the level of contamination in 57 collected human milk samples. PFOA and PFOS were present in 82.5% and 85.7% of the samples, respectively, while PFOA levels ranged between 120 and 247 pg/mL with a median of 147 pg/mL, and those of PFOS ranged between 12 and 86 pg/mL with a median of 27.5 pg/mL. The median contamination for PFOA exceeded the threshold set by the European Food Safety Authority (EFSA) (60 pg/mL); however, that of PFOS was below the threshold (73 pg/mL). The consumption of bread, pasta, meat, and chicken more than twice per week and that of white tubers and roots at least once per week was significantly associated with higher levels of PFOA (p < 0.05). No significant association was found between maternal age, BMI, parity, level of education, place of residence, source of water used, and smoking with the levels of PFOA and PFOS in the human milk. Additionally, the consumption of cereals at least twice per week was significantly associated with higher levels of PFOS. These findings call for actions to improve the local environmental and agricultural practices, and the regulations and standards for inspecting imported food. It is important to highlight that the benefits of breastfeeding outweigh the reported contamination with PFOS and PFOA in our study.

AIMS To test the effect of energy restriction with maintained protein intake on body composition and on insulin sensitivity of glucose and protein metabolism in adults with type 2 diabetes (T2D). MATERIALS AND METHODS After 3 days of an isoenergetic diet with 1.2 g/kg/d protein, obese adults with T2D (three women, two men) followed a 5-week diet providing 60% of energy requirements with 45% carbohydrate, and with protein maintained at pre-intervention level. Isotopic tracers were used to quantify whole-body glucose (3-3 H-glucose) and protein (13 C-leucine) metabolism pre- (day 4) and post-intervention (day 39), in the postabsorptive state and during a hyperinsulinaemic, isoglycaemic, isoaminoacidaemic clamp. Body composition was measured using dual-energy x-ray absorptiometry. RESULTS After energy restriction, 6% weight loss occurred via total body (11%) and visceral fat losses (25%), but lean mass was preserved. Fasting glucose level, serum insulin level, homeostatic model assessment of insulin resistance index and C-peptide level decreased significantly (29%, 38%, 54% and 38%, respectively) as did other cardiometabolic risk factors. Between clamp studies, postabsorptive protein turnover and oxidation rates decreased (12% and 32%), resulting in less negative net balance, consistent with protein conservation. The rates of glucose turnover decreased, and glucose metabolic clearance rate improved (24%). During the clamp, protein flux was lower (9%) and breakdown suppressed (12%), and net balance became less negative but not different. Although glucose turnover did not differ, metabolic clearance improved by 47%. CONCLUSIONS In obese adults with T2D, an energy-restricted diet with maintained protein intake of ~1.2 g/kg/d improved the kinetics of protein metabolism (particularly in the postabsorptive state), and preserved lean body mass and increased glucose metabolic clearance rate.

Studies on the association between gastric cancer (GC) and the intake of nutrients in Jordan are very limited, while findings from other reports on the intake of energy and macronutrients are controversial. This study aimed to examine the associations between intake of energy and macronutrients and the risk of GC in a Jordanian population. A case-control study was carried out between March 2015 and August 2018 in four major hospitals, including an oncology center in Jordan. Study participants were 173 cases with incident and histologically confirmed GC and 314 frequency-matched controls. Interview-based questionnaires were used to obtain the study’s information. Data on nutrient intake were collected using a validated Arabic food-frequency questionnaire (FFQ). Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated through multinomial logistic regression and adjusted for potential confounders, including age, marital status, education, body mass index (BMI), smoking, period of smoking, family history of gastric cancer, history of gastric ulcer, and physical activity. Intakes of total fat, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, trans-fat, and omega-6 fatty acids were significantly associated with increased risk of GC. The ORs for the highest versus the lowest tertiles were 6.47 (95% Cl: 3.29–12.77), 2.97 (95% CI: 1.58–5.58), 6.84 (95% CI: 3.46–13.52), 6.19 (95% CI: 3.15–12.17), 3.05 (95% CI: 1.58–5.88), 8.11 (95% CI: 4.20–15.69), and 2.74 (95% CI: 1.47–5.09), respectively. No significant association was found for energy, protein, carbohydrate, sugar, fibers, and omega-3 fatty acids. The findings of this study suggest that high intake of selected types of fats was associated with an increased risk of GC. This research was funded by the Hashemite University [1403938/10/13/16AM].

With the growing spread of COVID-19 worldwide, the appeal to alternative and nutritional therapies in conjunction with medical therapies has been heightened. This article aims to review studies assessing the roles of Chinese traditional medicine and nutrition in upper respiratory infections, including COVID-19. Various Chinese herbal protocols have been shown to fight respiratory infections, with several having been tested on the novel coronavirus. Additionally, promising findings have been reported when medical treatments were complemented with nutritional interventions. Supplementation with vitamins C and D, Zinc and Selenium are discussed, in addition to certain phytochemicals and food that also possess immunoregulatory and antiviral properties. Further clinical studies are needed to establish these alternative treatments as part of the management of emerging respiratory infections.

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care. Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world This pilot-study tested the effect of culturally-tailored education targeting diabetes self-care on glycaemia and cardiovascular risk factors of Lebanese with type 2 diabetes (T2DM). Methods: A sample of 27 adults (Age: 61±10yrs, 59% males, HbA1c:8.98±1.38%) with T2DM was recruited from primary health care centers in Beirut. Participants received culturally tailored, multidisciplinary education. Scales assessing self-care, social support, fatalism, and diabetes knowledge, as well as anthropometric measures, and blood samples were collected at baseline, 3-months and 6-months post- intervention. Results: Diabetes self-care (Diet, Self-Monitoring Blood Glucose and foot care) improved after 6 months, which was reflected in a significant drop in glycemic level (HbA1c:-0.5%; FPG: -38 mg/dl), and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29). Waist circumference decreased at 6 months compared to 3 months (p

A growing number of ethnic minority populations in the United States are from the Middle East and North Africa (MENA) region, specifically Lebanon. This region is witnessing one of the highest expected increases in diabetes prevalence. However, limited data exists on how social determinants of health impact clinical care for diabetes in this population. The aim of this study was to assess the social determinants of health and their impact on clinical outcomes in Lebanese adults with type 2 diabetes (T2DM).A convenience sample of Lebanese patients with T2DM was recruited from primary health care centers in Lebanon. Data on demographics and social determinants of health, including socioeconomic status, neighborhood and built environment, as well as psychosocial variables were collected. Clinical outcomes including Hemoglobin A1c (A1C), systolic (SBP) and diastolic blood pressure (DBP) were measured. Unadjusted and adjusted linear regression models were used to test for associations between the independent variables and each of the outcomes.Out of the 300 adults with T2DM, 52% were men, 73% were married and 64% had an education level below high school. Results from multivariate analyses showed that food insecurity (β = 0.16, p = 0.01), owning an air conditioner (β = -0.64, p = 0.01), and commuting by walking (β = -0.93, p = 0.01) were independently associated with A1C. Predictors of DBP were male gender (β = 3.59, p = 0.03), age (β = -0.19, p = 0.005) and lack of confidence in filling medical forms (β = -4.89, p = 0.007), while male gender was the only predictor of SBP (β = 7.41, p = 0.008).This is the first study to examine the relationship between social determinants of health and clinical outcomes for diabetes in the MENA region. Our findings suggest that living in an underprivileged neighborhood and built environment was significantly and independently associated with poor clinical outcomes among adults with T2DM in Lebanon. Findings from this study will inform care for immigrant populations with diabetes from the MENA region.

Despite their documented significance in type 2 diabetes (T2DM) management, social determinants of health (SDOHs) including material needs security are poorly studied in the Middle East and North Africa (MENA) region. This study aims to assess the relation between material needs security and clinical outcomes in Lebanese adults with T2DM.Subjects with T2DM (n = 300) were recruited; demographic and material need variables were collected using self-reported questionnaires. Measured clinical outcomes included Hemoglobin A1c (A1C), systolic (SBP) and diastolic blood pressure (DBP). Regression models were used to examine associations between material needs security and clinical outcomes, controlling for relevant confounding variables.Most of the participants were men, married and with lower education levels. Having higher material needs security and being employed predicted better A1C levels (p 0.05), whereas male sex was associated with poorer A1C(β = 0.52, p = 0.03) and DBP(β = 3.06, p = 0.05). Other predictors of DBP included older age and lack of confidence in filling out medical forms, reflecting lower health literacy.Our study highlights the importance of material needs in achieving optimal T2DM outcomes T2DM in the MENA region. Further research is needed to understand potential pathways/mechanisms and options for effective interventions.

Objective:To validate the European Prospective Investigation into Cancer (EPIC) FFQ in Lebanon.Design:Validation of the EPIC FFQ was done against three 24-h recalls (24-HR). Unadjusted and energy-adjusted correlations, Bland–Altman plots and weighed kappa statistics were used to assess the agreement between the two methods.Setting:Lebanon.Participants:119 adults (staff and students) at a Lebanese University.Results:Good unadjusted and energy-adjusted correlation coefficients were found between data from the two methods which ranged from –0·002 (vitamin A) to 0·337 (carbohydrates) and were all statistically significant except for vitamin D, vitamin E, vitamin A, Se and niacin. Slight/fair agreement was reported through weighed kappa estimates for unadjusted data ranging from –0·05 (vitamin C) to 0·248 (Mg) and for energy-adjusted data ranging from –0·034 (vitamin A) to 0·203 (P). Individuals were categorised into exact and adjacent quartiles with an average of 78 % for unadjusted data and 70 % for energy-adjusted data, indicating a very good agreement between the EPIC FFQ and the average of the 24-HR data. The visual inspection of the Bland–Altman plots revealed an overestimation of energy, carbohydrates, protein and fat intakes by the FFQ method.Conclusion:Overall, when all tests were taken into consideration, the current study demonstrated an acceptable agreement of the EPIC FFQ with the 24-h dietary recall method and significantly good correlations between dietary intakes. Therefore, the EPIC FFQ can be considered a valid tool for assessing diet in epidemiological studies among Lebanese adults.

Discrepancies in the characteristics of the food components of a Mediterranean diet exist based on the country of origin. In Lebanon, a traditional Mediterranean diet emphasizes the high intakes of fruits (including dried), vegetables, burghol, and dairy products. Therefore, this cross-sectional study aimed to explore the association between adherence to the Lebanese Mediterranean diet (LMD) and frailty among older adults in Lebanon. A total of 112 community-dwelling older adults aged ≥65 years were recruited. Demographic and clinical characteristics were collected through face-to-face interviews. A 61-item food frequency questionnaire (FFQ) was used to collect dietary intake data, and adherence to LMD was calculated. Physical frailty was defined by the presence of three out of the five criterion: weight loss, weakness, exhaustion, slowness, and low activity. Binary logistic regression was used to examine the relationship between LMD adherence and frailty while adjusting for several confounders. The participants’ mean age was 73 ± 12.8 and 65% were females. Sixteen (14.3%) individuals were identified as frail. Frail individuals were significantly older (p = 0.001), depressed (p < 0.001), at risk of cognitive impairment (p = 0.006), and reported polypharmacy (p = 0.003). No significant association was found between LMD adherence and frailty in fully adjusted models (OR = 0.195; 95% CI: 0.033–1.154; p = 0.071 when categorical and OR = 0.856; 95% CI: 0.668–1.097; p = 0.218 when continuous). We also performed additional analyses with a modified frailty index where house chores were not considered as part of leisure activities of the physical activity criterion. The results showed that a higher LMD adherence was associated with a significantly decreased frailty prevalence (OR = 0.123, 95% CI: 0.022–0.676, p = 0.016 when categorical and OR = 0.773, 95% CI 0.608–0.983, p = 0.036). Larger, longitudinal studies are needed to clarify the relationship between the adherence to the Lebanese Mediterranean diet and frailty in Lebanese older adults.

OBJECTIVES: Colic and allergy symptoms are problems encountered in the exclusively-breastfed newborn and are thought to be triggered by inflammatory responses in the gut. Maternal diet, especially cow's milk intake, has been associated with infantile colic and allergies, but no study examined the effect of Mediterranean diet. Thus, this study aims to investigate whether maternal adherence to a dairy-free Mediterranean diet, known for is anti-inflammatory properties, reduces colic and allergy symptoms in exclusively-breastfed infants. METHODS: Exclusively breastfeeding healthy primiparous women were recruited during their pregnancy third trimester and were randomly assigned to receive an education on dairy-free Mediterranean diet or no education (control group). Mother-infant pairs were followed up for 2 months postpartum and adherence to the diet was confirmed through 24 hour recalls. Data on infant fussing & crying using validated “Daily Crying Diary” (Barr, et al., 1988) and allergy symptoms using validated CDC's “Breastfeeding and Infant Feeding Practices postnatal questionnaire” (Centers for Disease Control and Prevention, 2017) were collected on weeks 2, 4 and 7 postpartum. Infant stool samples were also collected to test for blood, pH, and eosinophil cationic protein as estimates of the degree of inflammation in the gut. RESULTS: Preliminary data from 10 mother-infant pairs showed that there was no group differences in the weights of the mothers and infants and number of allergy symptoms throughout the study. Colic (defined by the “Wessel Criteria” as crying episodes that last for >3 hours per day, for ≥3 days per week and for ≥3 weeks) was not observed in any infant. Findings from “Daily Crying Diaries” revealed that maternal adherence to dairy-free Mediterranean diet was associated with significantly lower average daily crying compared to controls (0.28 vs. 1.10 hours/d) in infants. Results on infant stool blood, pH, and eosinophil cationic protein are still pending. CONCLUSIONS: Maternal adherence to a dairy-free Mediterranean diet did not affect allergy symptoms but decreased fussing and crying in exclusively breastfed infants. Mechanisms of action still remain to be determined. FUNDING SOURCES: Lebanese American University.

Background: The Lebanese American University has a well-functioning inter-professional education (IPE) programme; this is a fundamental pedagogical approach in healthcare education in which students from different professions learn together, ultimately leading to improving the skills of the health care workforce and thus improving patient outcomes. The programme includes nursing, nutrition, medicine, pharmacy and social work students, and has now been running for 6 years. Aims: This paper aims at describing the implementation of an IPE programme in Lebanon by focusing on how to overcome the main challenges. Methods: We describe our experience using the categories of challenges developed by Sunguya et al. (2014), where they analysed published reports of IPE programmes in developed countries. We identified three additional challenges that might be relevant throughout the Middle East/North Africa (MENA) region or in countries with similar socioeconomic characteristics.

Aflatoxin B1 (AFB1) is the most potent of the dietary aflatoxins, and its major metabolite, aflatoxin M1 (AFM1), is frequently found in the breast milk of lactating mothers. The aim of this study was to assess the occurrence and factors associated with AFM1 contamination of breast milk collected from lactating mothers in Lebanon. A total of 111 breast milk samples were collected according to the guidelines set by the World Health Organization. Samples were analyzed with a competitive enzyme-linked immunosorbent assay between December 2015 and November 2016. A survey was used to determine the demographic and anthropometric characteristics of participating lactating mothers. Dietary habits were assessed using a semiquantitative food frequency questionnaire. Mean (±standard deviation) concentration of AFM1 in the breast milk samples was 4.31 ± 1.8 ng/L, and 93.8% of samples contained AFM1 at 0.2 to 7.9 ng/L. The mean concentration of AFM1 was significantly lower (P 0.05) was observed between AFM1 concentrations in breast milk and anthropometric sociodemographic factors (age and level of education) or the governorate of residence of the nursing mothers. The mean AFM1 estimated daily intake was found to be 0.69 ng/day/kg of body weight. Although the incidence of AFM1 contamination was low, our first-of-its-kind study highlights the importance of conducting investigations on mycotoxin contamination in breast milk and of developing protection strategies to tackle the exposure of infants to this potent chemical hazard.

Background: Achieving and sustaining optimal glycemic control in type 2 diabetes (T2DM) is difficult because of socio-cultural and psychosocial factors including diabetes fatalism. Diabetes fatalism is ‘a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness’.Purpose: The purpose of this paper is to explore whether diabetes fatalism and other psychosocial and socio-cultural variables are correlates of glycemic control in Lebanese population with T2DM.Methods: A convenience sample of 280 adult participants with T2DM were recruited from a major hospital in greater Beirut-Lebanon area and from the community. Diabetes fatalism was assessed using the Arabic version of 12-item Diabetes Fatalism Scale. Multiple linear regression models were used to assess the relationship between HbA1c and psychosocial and socio-cultural characteristics including diabetes fatalism. Four models were run to examine the independent association between HbA1c and diabetes fatalis...

Disordered eating behaviors are on the rise among youth. The present study investigates psychosocial and weight-related variables as predictors of eating disorders (ED) through disordered eating (DE) dimensions (namely restrained, external, and emotional eating) in Lebanese university students. The sample consisted of 244 undergraduates (143 female) aged from 18 to 31 years (M = 20.06; SD = 1.67). Using path analysis, two statistical models were built separately with restrained and emotional eating as dependent variables, and all possible direct and indirect pathways were tested for mediating effects. The variables tested for were media influence, perfectionism, trait emotional intelligence, and the Big Five dimensions. In the first model, media pressure, self-control, and extraversion predicted eating disorders via emotional eating. In the second model, media pressure and perfectionism predicted eating disorders via restrained eating. Findings from this study provide an understanding of the dynamics between DE, ED, and key personality, emotion-related, and social factors in youth. Lastly, implications and recommendations for future studies are advanced.

Background: International T2DM Federation (IDF) estimates T2DM prevalence in Lebanese adults around 14%. Identifying people at risk of developing type 2 T2DM mellitus (T2DM) as to prevent rising prevalence and development of T2DM related complications is crucial. Aim: to identify people at high risk for developing T2DM. Methods: A convenience sample (N=198) of healthy Lebanese adults, 40 years of age and above, were recruited through snowballing from all over Lebanon. Food Frequency Questionnaire (FFQ), Short Test of Functional Health Literacy in Adults (STOFHLA), World Health Organization Quality of Life-BREF (WHOQoL-BREF), and ARABRISK were administered. Results: Majority of the participants were 40 to 54 years (74.25%), females (57.58%), married (51.02%), employed (59.90%) and reported having “enough to make ends meet” (64.29%). Significant association resulted between ARABRISK scale score and WHOQoL-BREF scale (β= -1.642, p= 0.001) as well as two of its subscales, physical (β= -2.21, p < 0.001) and psychological (β= -1.17, p= 0.003). Significant association was noted between ARABRISK scale score and demographic characteristics; mainly marital status, particularly being “married” (β= 15.47, p < 0.001) and “widowed/divorced” (β= 25.72, p < 0.001), and employment statuses particularly “not enough to make ends meet” (β= 8.64, p= .021).Significant association resulted between ARABRISK scale score and at whole grain consumption (β= -4.97, p = 0.035) and red meat (β= 13.02, p = 0.003). Marital status, red meat consumption, whole grains consumption, and physical health subscale were significantly associated with ARABRISK in the fully adjusted multiple linear regression model. The combination of the latter variables accounted for 36.83% of the variance of ARABRISK score. Conclusion: Findings will help health care practitioners to understand the determinants of T2DM risk, which will set the stage for effective preventive measures in reducing the risk and incidence of T2DM. Disclosure O.A. Sukkarieh-Haraty: None. J. Abi Kharma: None. N. Farran: None. M. Bassil: None. Funding Lebanese American University

The effect of eating behavior and personality on glycemic outcomes in type 2 diabetes (T2DM) has received little attention. Diabetes fatalism has furthermore been associated with uncontrolled glycemia. The aim of the present study is to explore the interrelationship of these constructs, which might uncover new insights for diabetes management. A total of 333 Lebanese patients (Age: 59 ± 13 years, 50.2% M) with T2DM were recruited. Eating behaviours (Dutch Eating Behaviour Questionnaire), personality traits (NEO Five-Factor Inventory-3), and diabetes related fatalistic attitudes (Diabetes Fatalism Scale) were assessed. Regression analyses showed that neuroticism, restrained eating, and external eating predicted A1C. Total diabetes fatalism and its ‘despair’ subscale also predicted HbA1C. Multiple regression analysis showed that neuroticism, restrained eating, and fatalism subscale ‘despair’ predicted HbA1C levels and explained 5.4% of the variance (F(3,302) = 5.77, p = .001). A moderated moderation was run and revealed that the effect of conscientiousness on restrained eating was moderated by powerlessness (fatalism subscale) and neuroticism. At low neuroticism levels and with any powerlessness levels, conscientiousness did not exert a significant effect on restrained eating. However, at high levels of neuroticism with low or moderate levels of powerlessness, conscientiousness exerted significant effect on restrained eating (low powerlessness: B = .07, t = 4.39, p < .001; medium powerlessness: B = .04, t = 3.24, p < .01). On the other hand, when powerlessness was high, conscientiousness did not exert a significant effect on restrained eating. In summary, the impact of conscientiousness on restrained eating, which in turn predicts HbA1C levels, is moderated by the belief of powerlessness and neuroticism in T2DM. These factors should be taken into account in the clinical practice. Further exploring similar constructs in T2DM to improve the quality of health care is warranted. Disclosure N. Farran: None. O.A. Sukkarieh-Haraty: None. D. Al Bakhour: None. M. Bassil: None.

Optimal diabetes management requires daily activities of self-care. Thus, understanding the sociodemographic determinants of diabetes self-care is crucial to improve diabetes control. The aim of this study is to compare diabetes self-care activities and their determinants in 2 populations of Arabs with type 2 diabetes (T2DM) living in their country of origin (Lebanon) or in the United States (U.S.). A total of 334 patients (59 ± 13 years; 52.1% M) living in Lebanon and 181 patients (62 ± 12 years; 52.5% M) living in the U.S. were recruited. Diabetes self-care activities were assessed using Summary of Diabetes Self-Care Activities Assessment (SDSCA); dimensions of diabetes distress were measured with the Diabetes Distress Scale (T1-DDS). Half of the population in Lebanon were employed, 61.6% had health insurance and 42.3% were smokers; while among those living in the U.S., 23.7% were employed, 96.1% had health insurance and 26.5% were smokers. There were no significant group differences for gender, marital status and education. Compared to those in Lebanon, patients living in the U.S. had significantly higher mean scores on various SDSCA subscales, including general diet (t = 5.24, p < 0.001), exercise (t = 3.31, p = 0.001), blood glucose testing (t = 4.41, p < 0.001), and foot care (t = 8.84, p < 0.001) indicating better diabetes self-care. Multiple regression analyses showed that total SDSCA scores correlated significantly with age (β= 0.06, p = 0.015) and education (β= 3.02, p=0.006) in patients living in Lebanon; whereas predictors of total SDSCA scores among participants living in the U.S. were education (β= 8.46, p = 0.005) and management distress subscale of T1-DDS (β= - 2.92, p < 0.001). In conclusion, Arab patients with T2DM living in the U.S. showed better diabetes self-care activities compared to those living in their country of origin. Predictors of self-care varied between the 2 populations. Further exploring other determinants is warranted. Disclosure O.A. Sukkarieh-Haraty: None. L. Jaber: None. J. Abi Kharma: None. N. Farran: None. M. Bassil: None.

How individuals respond to chronic stress varies. Susceptible individuals ultimately develop depression; whereas resilient individuals live normally. In this study, our objective was to examine the effect of branched-chain amino acids (BCAA), commonly used by athletes, on susceptibility to stress. Male C57BL/6 mice were subjected to daily defeat sessions by a CD1 aggressor, for 10 days. On day11, the behavior of mice was assessed using the social interaction test, elevated plus maze and open field. Mice received the BCAA leucine, isoleucine or valine before each defeat session. Furthermore, we examined whether BCAA regulate brain derived neurotrophic factor (BDNF) signaling by using a brain-permeable tropomyosin receptor kinase B (TRKB) inhibitor, ANA-12. We also tested the effect of voluntary exercise and high protein diets on susceptibility to stress. Mice exposed to chronic stress displayed increased susceptibility and social avoidance. BCAA promoted resilience to chronic stress, rescued social avoidance behaviors and increased hippocampal BDNF levels and TRKB activation. Inhibition of TRKB signaling abolished the ability of BCAA to promote resilience to stress and to rescue social avoidance. Interestingly, we found that BCAA activate the exercise-regulated PGC1a/FNDC5 pathway known to induce hippocampal BDNF signaling. Although both voluntary exercise and BCAA promoted resilience to stress, combining them did not yield synergistic effects confirming that they affect similar pathways. We also discovered that high protein diets mimic the effect of BCAA by rescuing social deficits induced by chronic stress and increase Bdnf expression in the hippocampus. Our data indicate that BCAA, exercise and high protein diets rescue susceptibility to stress by activating the hippocampal BDNF/TRKB signaling. Keywords: Branched chain amino acids, Chronic social defeat stress, BDNF, FNDC5, Exercise, High protein diet

Background: Enhancing diabetes self-care is known to improve glycemic control of patients with type 2 diabetes mellitus (T2DM). According to American Diabetes Association guidelines, a multidisciplinary and culturally appropriate intervention is needed for optimal diabetes self-care and glycemic outcomes. There is no published study that evaluated an educational intervention targeting diabetes self-care and glycemic outcomes in Lebanese patients with T2DM. Aim: The aim of this pilot-study was to test the effect of culturally-tailored educational program targeting diabetes self-care on glycemic control of Lebanese patients with T2DM, of low socioeconomic status. Methods: A sample of 27 adults (Age: 61±10 years, 59% males, A1C: 8.98±1.38%) diagnosed with T2DM for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on American Diabetes Association’s National Standards for Diabetes Self-Management Education and Support. Summary of Diabetes Self-Care Activities (SDSCA), Social Support Scale (SS), Diabetes Fatalism Scale (DFS), and Diabetes Knowledge Test (DKT), as well as blood samples (HbA1c, Fasting Plasma Glucose) were collected at baseline and three months post-intervention. Results: Results revealed improvements in various diabetes self-care activities (Diet and Self-Monitoring Blood Glucose) after 3 months, which was reflected in a significant decrease in glycaemia (A1C: -0.6%; Fasting Plasma Glucose: -35 mg/dl; p Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving glycemic control and diabetes self-care behavior of Lebanese patients with T2DM. It sets the stage for larger scale implementation with more representative sample. Disclosure O. Sukkarieh-Haraty: None. M. Bassil: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care, and is known to reduce cardiovascular risk factors of patients with type 2 diabetes (T2D) (American Diabetes Association [ADA], 2017). According to ADA, effective DSME is multidisciplinary, patient-centered, as well as age and culturally appropriate (ADA, 2017). Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world. Aims: The aim of this pilot-study was to test the effect of the first culturally-tailored educational program targeting diabetes self-care on cardiovascular risk factors of Lebanese patients with T2D. Methods: A sample of 27 adults (Age: 61±10 years, 59% M, A1C: 8.98±1.38%) diagnosed with T2D for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on ADA’s National Standards for Diabetes Self-Management Education and Support. Anthropometric measures (weight, height, BMI, waist circumference, body fat mass and fat-free mass) and blood samples (Triglycerides, Total, LDL and HDL cholesterol) were collected at baseline, 3 months and 6 months post-intervention. Results: Waist circumference (107.52±12.91 vs. 106.59±12.01) and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29) decreased at 6 months post-intervention (p=0.02). Discussion and Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving body adiposity and blood lipids of Lebanese patients with T2D, and thus reducing their cardiovascular risk factors. It sets the stage for larger scale implementation with more representative sample. Disclosure M. Bassil: None. O. Sukkarieh-Haraty: None. J.L. Abi Kharma: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..

Background There are widespread fatalistic beliefs in Arab countries, especially among individuals with diabetes. However, there is no tool to assess diabetes fatalism in this population. This study describes the processes used to create an Arabic version of the Diabetes Fatalism Scale (DFS) and examine its psychometric properties. Methods A descriptive correlational design was used with a convenience sample of Lebanese adults (N = 274) with type 2 diabetes recruited from a major hospital in Beirut, Lebanon and by snowball sampling. The 12- item Diabetes Fatalism Scale- Arabic (12-item DFS-Ar) was back-translated from the original version, pilot tested on 22 adults with type 2 diabetes and then administered to 274 patients to assess the validity and reliability of the scale. Confirmatory factor analysis (CFA) was used to test the hypothesized factor structure. Cronbach’s alpha was used to test for reliability. Results CFA supported the existence of the three factor hypothesis of the original DFS scale. The five items measuring “emotional distress” loaded under Factor 1, the four items measuring “spiritual coping” loaded under factor 2 and the last three items measuring “perceived self-efficacy” of the original scale loaded under Factor 3 (p

Introduction Exposure of newborns to toxic metals is of special interest due to their reported contamination in breast milk and potential harm. The aim of this study was to assess the occurrence and factors associated with lead, cadmium and arsenic contamination in breast milk collected from lactating mothers in Lebanon. Methods A total of 74 breast milk samples were collected from primaparas according to guidelines set by the World Health Organization. A survey was administered to determine the demographic and anthropometric characteristics of participating lactating mothers. Dietary habits were assessed using a semi-quantitative food frequency questionnaire. The milk samples were analyzed for the presence of arsenic, cadmium and lead using microwave-assisted digestion and atomic absorption spectrophotometry. Results Arsenic contamination was found in 63.51% of breast milk samples (mean 2.36 ± 1.95 μg/L) whereas cadmium and lead were detected in 40.54% and 67.61% of samples respectively (means 0.87 ± 1.18 μg/L and 18.18 ± 13.31 μg/L). Regression analysis indicated that arsenic contamination was associated with cereal and fish intake (p = 0.013 and p = 0.042 respectively). Residence near cultivation activities (p = 0.008), smoking status before pregnancy (p = 0.046), potato consumption (p = 0.046) and education level (p = 0.041) were associated with lead contamination. Cadmium contamination was significantly associated with random smoke exposure (p = 0.002). Conclusion Our study is the first in Lebanon to report toxic metal contamination in breast milk. Although estimated weekly infant intake of these metals from breast milk was found to be lower than the limit set by international guidelines, our results highlight the need for developing strategies to protect infants from exposure to these hazardous substances.

Objective In insulin-resistant states, resistance of protein anabolism occurs concurrently with that of glucose, but can be compensated for by abundant amino acid (AA) provision. This effect and its mechanism were sought in obesity. Methods Pancreatic clamps were performed in 8 lean and 11 obese men, following 5-h postabsorptive, 3-h infusions of octreotide, basal glucagon, and growth hormone, with clamped postprandial-level insulin, glucose, and AA. Whole-body [1-13C]-leucine and [3-3H]-glucose kinetics, skeletal muscle protein (2H5-phenylalanine) fractional synthesis rates, and insulin signaling were determined. Results Clamp Δ insulin and Δ branched-chain AA did not differ; fasting glucagon and growth hormone were maintained. Glucose uptake was 20% less in obese concurrent with less AktSer473, but also less IRS-1Ser636/639 phosphorylation. Stimulation of whole-body, myofibrillar, and sarcoplasmic protein synthesis was similar. Whole-body protein catabolism suppression tended to be less (P=0.06), resulting in lesser net balance (1.09 ± 0.07 vs. 1.31 ± 0.08 μmol [kg FFM−1] min−1, P = 0.048). Increments in muscle S6K1Thr389 phosphorylation were less in the obese, but 4E-BP1Ser65 did not differ. Conclusions Hyperaminoacidemia with hyperinsulinemia stimulated protein synthesis (possibly via nutrient signaling) normally in obesity, but suppression of proteolysis may be compromised. Whether long-term high protein intakes could compensate for the insulin resistance of protein anabolism remains to be determined.

The Lebanese American University Interprofessional Education (LAU IPE) Steps Framework consists of a five-step workshop-based series that is offered throughout the curriculum of health and social care students at an American university in Lebanon. The aim of the present study was to report students' perceptions of their readiness for interprofessional learning before and after completing the IPE steps, their evaluations of interprofessional learning outcomes, as well as their satisfaction with the learning experience as a whole. A longitudinal survey design was used: questionnaires were completed by students before IPE exposure and after each step. The results showed that before IPE exposure, students' perceptions of their readiness for interprofessional learning were generally favourable, with differences across genders (stronger professional identity in females compared to males) and across professions (higher teamwork and collaboration in pharmacy and nutrition students compared to other professions and lower patient centredness in nursing students compared to others). After participation in the IPE steps, students showed enhanced readiness for interprofessional learning and differences between genders and professions decreased. Participants were satisfied with the learning experience and assessment scores showed that all IPE learning outcomes were met. The LAU IPE Steps Framework may be of value to other interprofessional education course developers.

Aim: The study was designed to investigate the immediate (1 h) effect of leptin and ghrelin injection on in vivo postprandial hepatic glycogen and lipid synthesis. Animals andMethods: Adult Sprague-Dawley male rats were fed a semisynthetic control diet ad libitum. Overnight-fasted rats were gavaged with 4 ml of water containing 1.25 g of the diet and immediately injected intraperitoneally with 4 mCi of 3H2O. After 1 h, rats were either intraperitoneally injected with saline (control), leptin (20 µg/rat) or ghrelin (10 µg/rat) and sacrificed 1 h later. Blood, liver and epididymal fat pads (EFP) were taken for analysis. Results: Plasma triglyceride level was higher in the leptin group compared to control. Leptin injection reduced hepatic glycogen synthesis while glycogen accumulation was not affected and ghrelin injection did not affect hepatic glycogen synthesis. Both hepatic and EFP lipogenesis were not affected by leptin or ghrelin. Conclusion: Leptin and ghrelin administration had no immediate effect on hepatic and adipose tissue lipogenesis. Leptin reduced in vivo postprandial hepatic glycogenesis and increased plasma triglyceride level which may be due to reduced uptake by peripheral tissues. Thus, leptin was found to exert an immediate effect on lipid and carbohydrate metabolism unlike that of ghrelin.

Diet induced thermogenesis (DIT) of obese subjects was reported to be blunted or lower than that of lean subjects (Ravussin & Swinburn, 1996). We have previously found that phosphorus (P) supplementation increases DIT of glucose solution in healthy lean subjects (Bassil et al, 2013) probably due to an increase in postprandial ATP production. A study was conducted to investigate whether P supplementation is able to stimulate DIT of overweight and obese subjects. DIT of glucose solution was measured with or without P in 12 overweight and obese subjects (4M, 8F; Age=22.4±1.2y; BMI= 30.3 ±0.9kg/m2) in a double-blind cross over design with 1 week washout period. After a 10-h overnight fast, subjects drank a standardized 296mL solution containing 75g glucose, with P (500mg) or placebo pills. Oxygen consumption (VO2) was measured every 30 min for 3 hours using an indirect calorimeter to derive energy expenditure. Baseline fasting resting metabolic rate (RMR) and VO2 did not differ between the 2 experiments (p=0....

Background Epidemiological studies have found a U-shaped relationship between serum phosphorus and cardiovascular disease (CVD). The mechanism(s) behind such a relationship are poorly understood. Phosphorus (P) is reported to improve insulin sensitivity, which is involved in lipid metabolism, and thus we were interested in determining the impact of phosphorus ingestion on postprandial lipemia, a recognized CVD risk factor. Findings A within–subject study design was conducted, whereby 8 healthy male subjects received a high fat meal (330Kcal; 69% energy from fat; 35 mg of phosphorus) with placebo or phosphorus (500 mg) in a random order. Postprandial blood samples (~10 ml) were collected every hour for 6 hours after meal ingestion. Changes in different parameters were analyzed using a 2-factor repeated-measure ANOVA. In the phosphorus (P) supplemented group, postprandial serum P increased (p = 0.00), while changes in insulin, non-esterified fatty acids (NEFA) and triglyceride (TG) were not significantly different than that of placebo. Concurrently, phosphorus supplementation increased postprandial concentrations of apolipoprotein B48 (ApoB48) (p

Exposure to an enriched environment (EE) or the intake of a highly palatable diet may reduce the response to chronic stress in rodents. To further explore the relationships between EE, dietary intake and stress, male Sprague–Dawley rats were fed one of two diets for 5 weeks: high carbohydrate (HC) or “cafeteria” (CAF) (Standard HC plus a choice of highly palatable cafeteria foods: chocolate, biscuits, and peanut butter). In addition, they were either housed in empty cages or cages with EE. After the first two weeks, half of the animals from each group were stressed daily using a chronic variable stress (CVS) paradigm, while the other half were kept undisturbed. Rats were sacrificed at the end of the 5-week period. The effects of stress, enrichment and dietary intake on animal adiposity, serum lipids, and stress hormones were analyzed. Results showed an increase in intra-abdominal fat associated with the CAF diet and an increase in body weight gain associated with both the CAF diet and EE. Furthermore, the increase in ACTH associated with CVS was attenuated in the presence of EE and the CAF diet independently while the stress-induced increase in corticosterone was reduced by the combination of EE and CAF feeding. The present study provides evidence that the availability of a positive environment combined to a highly palatable diet increases resilience to the effects of CVS in rats. These results highlight the important place of palatable food and supportive environments in reducing central stress responses.

In insulin-resistant states, resistance of protein anabolism occurs concurrently with that of glucose, but can be compensated for by abundant amino acid (AA) provision. This effect and its mechanism were sought in obesity.Pancreatic clamps were performed in 8 lean and 11 obese men, following 5-h postabsorptive, 3-h infusions of octreotide, basal glucagon, and growth hormone, with clamped postprandial-level insulin, glucose, and AA. Whole-body [1-(13) C]-leucine and [3-(3) H]-glucose kinetics, skeletal muscle protein ((2) H5 -phenylalanine) fractional synthesis rates, and insulin signaling were determined.Clamp Δ insulin and Δ branched-chain AA did not differ; fasting glucagon and growth hormone were maintained. Glucose uptake was 20% less in obese concurrent with less Akt(Ser473) , but also less IRS-1(Ser636/639) phosphorylation. Stimulation of whole-body, myofibrillar, and sarcoplasmic protein synthesis was similar. Whole-body protein catabolism suppression tended to be less (P=0.06), resulting in lesser net balance (1.09 ± 0.07 vs. 1.31 ± 0.08 μmol [kg FFM(-1) ] min(-1) , P=0.048). Increments in muscle S6K1(Thr389) phosphorylation were less in the obese, but 4E-BP1(Ser65) did not differ.Hyperaminoacidemia with hyperinsulinemia stimulated protein synthesis (possibly via nutrient signaling) normally in obesity, but suppression of proteolysis may be compromised. Whether long-term high protein intakes could compensate for the insulin resistance of protein anabolism remains to be determined.

Shoug Al Nafeesi, Nadine Zeeni, Maya Bassil, Mariana Ibrahim, Tala Zein, Gilles Fromentin, Catherine Chaumontet and Costantine Daher Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Byblos, Lebanon CNRH-IdF, UMR 914 Nutrition Physiology, AgroParisTech, Paris, France Shoug.nafeesi@lau.edu, Nadine.zeeni@lau.edu.lb, mbassil@lau.edu.lb, mariana.ibrahim@lau.edu, tala.zein@lau.edu, Gilles.fromentin@agroparistech.com, Catherine.chaumontet@agroparistech.com

Thermic effect of food (TEF) is believed to be largely related to ATP production that is known to depend on phosphorus (P) availability. We hypothesised that the addition of P to a glucose load wou...

Purpose of review Protein anabolism is abnormal in human type 2 diabetes (T2DM). We review studies of anabolic stimuli that identify potential causes. If uncorrected, and combined with aging effects, they will compromise muscle function and mass. Knowing causes can guide studies of preventive and treatment measures. Recent findings T2DM accelerates age-related decreases in muscle mass. This could be related to insulin resistance of whole-body protein anabolism demonstrated in hyperglycemic obese men. In contrast, their protein anabolic response to hyperaminoacidemia suggested that ample amino acid administration, especially branched chain amino acids might overcome such insulin resistance. One study of chronic leucine supplementation in elderly T2DM patients did not increase muscle mass. However, they lacked sarcopenia and had adequate dietary protein intake, so may be atypical. Exercise induced similar increases in muscle protein synthesis, mass and strength in healthy and T2DM patients suggesting that physical activity might also overcome insulin resistance of protein anabolism. Summary Muscle protein anabolism in T2DM is resistant to the action of insulin but perhaps not to amino acid supply or exercise. Whether leucine supplementation improves muscle mass and function in persons with T2DM (especially elderly) with reduced protein intake or muscle mass needs to be determined.

Very little is known about media violence and its effect on appetite and eating behavior. The present study aims at investigating the immediate acute effect of violence in movies on mood, stress, appetite perception and food preferences in a real-life setting. A total of 447 subjects (F = 202; M = 239) completed a validated visual analog scale to record their subjective feelings of hunger, satiety and desire to eat immediately at their way out of any of the three types of movies (horror, romance/comedy and drama/action). There was a significant difference between the three movie categories for the tensed feeling (P = 0.003), anxiety (P = 0.021), the sleepy feeling (P = 0.000) and a preference to eat something sweet (P = 0.019). Horror/violence movie types affected the subject by making him feel more stressed and anxious; however, romance made him feel sleepier and less tensed. Movie types did not seem to affect hunger or appetite directly, but rather triggered some food preferences.

Aims/hypothesis Hyperaminoacidaemia attenuates glucose disposal during hyperinsulinaemic clamps in healthy lean individuals, an effect thought to be mediated by negative feedback on insulin signalling, downstream of the mammalian target of rapamycin (mTOR) signalling pathway. This has been interpreted as amino acids causing insulin resistance in healthy people, and contributing to it in type 2 diabetes. However, the effect of hyperaminoacidaemia on glucose disposal in type 2 diabetic individuals remains to be determined. Methods Eight obese men with type 2 diabetes underwent a two-step hyperinsulinaemic–hyperglycaemic (8 mmol/l) clamp, first with amino acids at postabsorptive concentrations, followed by postprandial concentrations. Wholebody glucose turnover was assessed using D-[3- 3 H]glucose. Vastus lateralis biopsies were obtained at baseline and during each step of the clamp to determine the phosphorylation states of AKT, mTOR, ribosomal protein (rp) S6, and insulin receptor substrate (IRS)-1. Results Rates of glucose infusion (1.30±0.19 vs 1.15± 0.13 mmol/min), endogenous glucose production (0.48±0.06 vs 0.53±0.05 mmol/min) and disposal (1.24±0.17 vs 1.17± 0.14 mmol/min) did not differ between postabsorptive and postprandial amino acid concentrations (p>0.05). Whereas phosphorylation of AKT Ser473 , AKT Thr308 mTOR Ser2448 and rpS6 Ser235/236 increased (p

Reduced 24h net protein balance in hyperglycemic T2D was explained by less protein accretion during hyperinsulinemic euglycemic, isoaminoacidemic (isoAA) clamps. We tested whether protein anabolism...

BASSIL, MAYA S., NAHLA HWALLA, AND OMAR A. OBEID. Meal pattern of male rats maintained on histidine-, leucine-, or tyrosine-supplemented diet. Obesity. 2007;15: 616–623. Objective: Food intake is known to be affected by macronutrient composition of the diet, and protein manipulation has been reported to alter food intake, but the effect of individual amino acids on eating behavior has not been fully studied. This study investigated the effect of diet supplementation with three individual amino acids on meal pattern in male rats. Research Methods and Procedures: Thirty-two SpragueDawley rats were randomly divided into four equal groups and fed control diet or histidine (5%)-, leucine (5%)-, or tyrosine (5%)-supplemented diet for 2 weeks and were monitored for their meal pattern. Results: Total food intake and feeding rate of the different groups were not affected, although other components of meal pattern were altered. Histidine supplementation reduced diurnal meal size by 42% (p 0.05), whereas that of leucine increased nocturnal meal size by 35% (p 0.05). Tyrosine supplementation increased food intake of the nocturnal period and decreased that of the diurnal period. Both histidine and tyrosine supplementation elevated fasting plasma insulin levels and suppressed fasting glucose significantly. Discussion: Individual amino acids were found to alter

Background: Phosphorus status is inversely correlated with body weight; however, the effect of phosphorus supplementation on body weight in a controlled design has not been studied. Methods: This is a double-blind, randomized, placebo-controlled trial of 63 adults aged 18–45 years with a body mass index (BMI) of ⩾25 kg m−2 and normal kidney function at the American University of Beirut. Participants were randomly assigned to the placebo or phosphorus group where daily placebo or phosphorus supplements were ingested with three main meals (breakfast, lunch and dinner) for a period of 12 weeks. Primary outcomes were changes in anthropometric measures, blood metabolites (including lipid profile, glucose and insulin) and subjective appetite scores. The trial is registered with Clinical Trial.gov, NCT02329990. Results: Body weight was significantly lower in the phosphorus group when compared with the placebo group (−0.65 kg (95% confidence interval (CI) −1.69 to 0.40) vs 1.13 kg (95% CI 0.19 to 2.06), P=0.01). Similarly, BMI and waist circumference were significantly lower in the phosphorus group when compared with the placebo group (−0.24 kg m−2 (95% CI −0.59 to 0.12) vs 0.42 kg m−2 (95% CI 0.05 to 0.78), P=0.01; −3.62 cm (95% CI−4.90 to −2.33) vs 0.38 cm ( 95% CI−0.44 to 1.20), P Conclusions: Phosphorus supplementation for 12 weeks significantly decreases body weight, BMI, waist circumference and subjective appetite scores. These findings support a promising role of the mineral phosphorus in the prevention and management of obesity, especially abdominal adiposity. The exact mechanisms of action and longer-term effects still need to be elucidated.

Background Salvia libanotica (S. Libanotica) is a commonly used herb in folk medicine in Lebanon and the Middle East. The present study aimed to assess the scientific basis for the therapeutic use of S. libanotica in glycemia and to evaluate its effects on lipemia and abdominal fat. Methods Animals were fed a high-fat diet and allocated into a control and three experimental groups (GI, GII and GIII) receiving incremental doses of the plant water extract in drinking water (50, 150 and 450 mg/Kg body weight respectively) for six weeks. Results The intake of S. libanotica extract was associated with a significant decrease in fasting serum glucose (102.9 ± 10.8 in GII and 87.5 ± 6.4 in GIII vs. 152.1 ± 7.9 mg/dl in controls) and a two fold increase in fasting serum insulin (GIII) and liver glycogen content (GII and GIII). Group III also had better glucose tolerance following intraperitoneal glucose challenges. Additionally, the plant extract intake produced a significant improvement in serum HDL (34.4 ± 2.4 in GIII vs. 27.2 ± 1.9 mg/dl in controls) and HDL/LDL cholesterol ratio (2.79 ± 0.32 in GII and 3.02 ± 0.31 in GIII vs. 1.74 ± 0.18 in controls), as well as a decrease in abdominal fat. Conclusion The current study is the first to demonstrate that the chronic intake of S. libanotica infusion helps in the prevention of high fat-induced hyperglycemia and dyslipidemia. This supports the plant use as a remedy for the prevention of type 2 diabetes and cardiovascular diseases.